AES 2008: Neuroinfections Growing Cause of Epilepsy Worldwide

Allison Gandey

December 19, 2008

December 19, 2008 (Seattle, Washington) — Neurologists are seeing more infectious and parasitic disorders than ever before, and many are facing the challenge of treating epilepsy in the context of what might appear to be mystifying symptomatology. To discuss this issue, a panel of 5 world experts presented at the recent AES 2008: the American Epilepsy Society (AES) 62nd Annual Meeting.

Cochairs Marco Medina and Samuel Wiebe in front with presenters behind — Hector Hugo Garcia, Angelina Kakooza-Mwesige, and Charles Newton.

The group, organized by the International League Against Epilepsy, provided attendees with an overview of neuroinfections around the world and offered insight on treatment.

Neurocysticerosis Leading Cause of Epilepsy

Hector Hugo Garcia, MD, from the Universidad Peruana Cayetano Heredia, in Lima, and the well-known neurocysticercosis working group in Peru, presented during the session. Neurocysticercosis is reportedly the leading cause of epilepsy in the developing world. Dr. Garcia pointed out that study of such conditions provides a unique opportunity to understand the mechanisms of epilepsy and ways they might eventually be altered.

"Many of these conditions are not only treatable, but preventable," session cochair Samuel Wiebe, MD, from the Foothills Medical Centre, in Calgary, Alberta, told Medscape Neurology & Neurosurgery. "There is great potential to reduce the burden of epilepsy around the world."

Dr. Garcia recommended that neurologists treat the symptoms of epilepsy first and consider antiparasitic agents only after the patient is well controlled. "Antiparasitics should only be used if the parasite is still alive," he emphasized, "and often this is not the case."

Among the other presenters was Shichuo Li, MD, president of the Chinese Association Against Epilepsy. Dr. Li is from Beijing University and has held various positions with the World Health Organization. He discussed central nervous system infections and their growing role in epilepsy. Dr. Li outlined the way these infections are increasing internationally and contributing to the global burden of epilepsy.

AIDS and Epilepsy

Angelina Kakooza-Mwesige, MD, from Makerere University, in Kampala, Uganda, presented on seizures in the context of HIV and AIDS. An estimated 30% of people with HIV or AIDS develop seizures. Dr. Mwesige said that given the number of people affected, the healthcare implications are enormous.

Worldwide, she said, there are 7400 new HIV infections a day, 1000 of these in children younger than 15 years. Most of these cases — 68% — are in Africa, and the remaining 32% occur in the rest of the world.

Treating epilepsy in patients on antiretroviral agents is complex, she noted, and further complicated by the lack of access to drugs in many parts of Africa, leaving physicians with only older-generation options.

The social implications are also difficult for patients, Dr. Mwesige told the meeting. "HIV patients who also have epilepsy have 2 highly stigmatizing conditions. Most patients are more comfortable telling their loved ones they have epilepsy than HIV, but they have both to deal with and it is hard."

Malaria and Seizures

Prof. Charles Newton, from the Kenya Medical Research Institute, in Kilifi, also presented at the meeting. He described the link between malaria and epilepsy.

An estimated 2 billion people are exposed to malaria each year, he said. It is a problem with enormous healthcare implications and, given the epileptogenic potential of plasmodium falciparum, should be taken very seriously, Prof. Newton noted. P falciparum is a cause of malaria in humans.

"Early diagnosis and treatment are important, and efforts to predict who may develop neurological sequelae will also be helpful," Dr. Wiebe added during an interview.

William Theodore, MD, chief of clinical epilepsy at the National Institute of Neurological Disorders and Stroke, described other neuroinfections that can play a role in epilepsy, such as meningitis and encephalitis.

Dr. Theodore outlined the epileptogenic mechanisms of these infections and described efforts to define, on a molecular level, how certain viruses overcome the body's defense mechanism and interact with target cells.

The World Health Organization has recognized neuroinfections as the leading preventable, treatable cause of epilepsy worldwide. Experts are recommending public-health measures, such as improved sanitation, education, diagnosis and treatment, and vaccination programs.

"There are very few treatment guidelines in this area," Dr. Wiebe added. "This makes it difficult for neurologists." Dr. Wiebe is part of the North American Commission of the International League Against Epilepsy and hopes talks such as the one at the AES will raise awareness.

The researchers have disclosed no relevant financial relationships.

AES 2008: American Epilepsy Society 62nd Annual Meeting. Presented December 8, 2008.

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